Understanding the Common Cold Irritation of nasal mucosa often triggers the sneeze reflex. Mucosal irritation also causes release of several inflammatory and vasoactive substances, dilating small blood vessels in the nasal sinuses and causing nasal congestion.

Irritation of nasal mucosa often triggers the sneeze reflex.

Mucosal irritation also causes release of several inflammatory and vasoactive substances, dilating small blood vessels in the nasal sinuses and causing nasal congestion.

Treatment of the Common Cold Involves combined use of antihistamines, nasal decongestants, antitussives, and expectorants. Treatment is SYMPTOMATIC only, not curative. Symptomatic treatment does not eliminate the causative pathogen.

Involves combined use of antihistamines, nasal decongestants, antitussives, and expectorants.

Treatment is SYMPTOMATIC only, not curative.

Symptomatic treatment does not eliminate the causative pathogen.

Instructors may want to use EIC Image #83: Upper Respiratory Tract

Treatment of the Common Cold Difficult to identify whether cause is viral or bacterial. Treatment is “empiric therapy,” treating the most likely cause. Antivirals and antibiotics may be used, but viral or bacterial cause may not be easily identified.

Difficult to identify whether cause is viral or bacterial.

Treatment is “empiric therapy,” treating the most likely cause.

Antivirals and antibiotics may be used, but viral or bacterial cause may not be easily identified.

Antihistamines: Traditional Older Work both peripherally and centrally Have anticholinergic effects, making them more effective than nonsedating agents in some cases Examples: diphenhydramine (Benadryl) chlorpheniramine (Chlor-Trimeton)

Traditional

Older

Work both peripherally and centrally

Have anticholinergic effects, making them more effective than nonsedating agents in some cases

Nursing Implications: Antihistamines Instruct patients to report excessive sedation, confusion, or hypotension. Avoid driving or operating heavy machinery, and do not consume alcohol or other CNS depressants. Do not take these medications with other prescribed or OTC medications without checking with prescriber.

Nasal Decongestants: Mechanism of Action Site of action: blood vessels surrounding nasal sinuses Adrenergics Constrict small blood vessels that supply URI structures As a result, these tissues shrink and nasal secretions in the swollen mucous membranes are better able to drain Nasal stuffiness is relieved

Site of action: blood vessels surrounding nasal sinuses

Adrenergics

Constrict small blood vessels that supply URI structures

As a result, these tissues shrink and nasal secretions in the swollen mucous membranes are better able to drain

Nasal stuffiness is relieved

Nasal Decongestants: Mechanism of Action Site of action: blood vessels surrounding nasal sinuses Nasal steroids Anti-inflammatory effect Work to turn off the immune system cells involved in the inflammatory response Decreased inflammation results in decreased congestion Nasal stuffiness is relieved

Site of action: blood vessels surrounding nasal sinuses

Nasal steroids

Anti-inflammatory effect

Work to turn off the immune system cells involved in the inflammatory response

Nasal Decongestants: Therapeutic Uses Relief of nasal congestion associated with: Acute or chronic rhinitis Common cold Sinusitis Hay fever Other allergies May also be used to reduce swelling of the nasal passage and facilitate visualization of the nasal/pharyngeal membranes before surgery or diagnostic procedures.

Relief of nasal congestion associated with:

Acute or chronic rhinitis

Common cold

Sinusitis

Hay fever

Other allergies

May also be used to reduce swelling of the nasal passage and facilitate visualization of the nasal/pharyngeal membranes before surgery or diagnostic procedures.

Cough Physiology Respiratory secretions and foreign objects are naturally removed by the cough reflex Induces coughing and expectoration Initiated by irritation of sensory receptors in the respiratory tract

Respiratory secretions and foreign objects are naturally removed by the

Coughing Most of the time, coughing is beneficial Removes excessive secretions Removes potentially harmful foreign substances In some situations, coughing can be harmful, such as after hernia repair surgery

Most of the time, coughing is beneficial

Removes excessive secretions

Removes potentially harmful foreign substances

In some situations, coughing can be harmful, such as after hernia repair surgery

Antitussives Drugs used to stop or reduce coughing Opioid and nonopioid (narcotic and non-narcotic) Used only for NONPRODUCTIVE coughs!

Nursing Implications: Antitussive Agents Perform respiratory and cough assessment, and assess for allergies. Instruct patients to avoid driving or operating heavy equipment due to possible sedation, drowsiness, or dizziness. If taking chewable tablets or lozenges, do not drink liquids for 30 to 35 minutes afterward.

Perform respiratory and cough assessment, and assess for allergies.

Instruct patients to avoid driving or operating heavy equipment due to possible sedation, drowsiness, or dizziness.

If taking chewable tablets or lozenges, do not drink liquids for 30 to 35 minutes afterward.

Nursing Implications: Antitussive Agents Report any of the following symptoms to the caregiver: Cough that lasts more than a week A persistent headache Fever Rash Antitussive agents are for NONPRODUCTIVE coughs. Monitor for intended therapeutic effects.

Report any of the following symptoms to the caregiver:

Cough that lasts more than a week

A persistent headache

Fever

Rash

Antitussive agents are for NONPRODUCTIVE coughs.

Monitor for intended therapeutic effects.

Expectorants

Expectorants Drugs that aid in the expectoration (removal) of mucus Reduce the viscosity of secretions Disintegrate and thin secretions

Drugs that aid in the expectoration (removal) of mucus

Reduce the viscosity of secretions

Disintegrate and thin secretions

Expectorants: Mechanisms of Action Direct stimulation or Reflex stimulation Final result: thinner mucus that is easier to remove

Direct stimulation

or

Reflex stimulation

Final result: thinner mucus that is easier to remove

Expectorants: Mechanism of Action Direct stimulation: The secretory glands are stimulated directly to increase their production of respiratory tract fluids. Examples: terpin hydrate, iodine-containing products such as iodinated glycerol and potassium iodide (direct and indirect stimulation)

Direct stimulation:

The secretory glands are stimulated directly to increase their production of respiratory tract fluids.

Nursing Implications: Expectorants Expectorants should be used with caution in the elderly, or those with asthma or respiratory insufficiency. Patients taking expectorants should receive more fluids, if permitted, to help loosen and liquefy secretions. Report a fever, cough, or other symptoms lasting longer than a week. Monitor for intended therapeutic effects.

Expectorants should be used with caution in the elderly, or those with asthma or respiratory insufficiency.

Patients taking expectorants should receive more fluids, if permitted, to help loosen and liquefy secretions.

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